Page 1 of 3

X Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM079  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  CASEY'S GENERAL STORE #3494 Address  421 N DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   MOMENCE Zip Code   60954
 
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
 
FOOD
18
 
1
 Pre-flushed, scraped, soaked
34
  
1
 Outside storage area, enclosures properly constructed, clean: controlled incineration
*1
  
5
 Source, Wholesome, No Spoilage
19
  
2
 Wash, rinse after: clean, proper temperature
2
X
1
 Original Container, Properly Labeled
*20
  
4
 Sanitization rinse: Clean, temperature, concentration   INSECT, RODENT ANIMAL CONTROL
 
FOOD PROTECTION
*35
  
4
 Presence of insects/rodents - outer openings protected; no birds, turtles, or other animals
*3
X
5
 Potentially hazardous food meets temperature requirements during storage, preparation, display, service and transportation
21
  
1
 Wiping cloths: clean, use restricted
22
  
2
 Food contact surfaces of equipment and utensils clean, free of abrasives and detergents  
FLOORS WALLS AND CEILINGS
36
  
1
 Floor: constructed, drained, clean, good repair, covering installation, dustless cleaning methods
*4
  
4
 Facilities to maintain product temperature
23
 
1
 Non-food contact surfaces of equipment and utensils clean
5
 
1
 Thermometers provided and conspicuous
37
  
1
 Walls, ceiling, attached equipment: constructed good repair, clean surfaces, dustless cleaning methods
6
 
2
 Potentially hazardous food properly thawed
24
  
1
 Storage, handling of clean equipment utensils
*7
  
4
 Unwrapped and potentially hazardous food not re-served, Cross Contamination
25
  
1
 Single-service articles, storage, dispensing  
LIGHTING
26
  
2
 No re-use of single-service articles
38
  
1
 Lighting provided as required - Fixtures shielded
8
X
2
 Food protection during storage, preparation, display, service and transportation  
WATER
  
VENTILATION
*27
 
5
 Water source, safe: Hot and cold under pressure
39
  
1
 Rooms and equipment - vented as required
9
  
2
 Handling of food(ice) minimized, methods  
SEWAGE
  
DRESSING ROOMS
10
  
1
 Food(ice) dispensing utensils properly stored
*28
  
4
 Sewage and waste water disposal
40
  
1
 Rooms clean, lockers provided, facilities clean
 
PERSONNEL
  
PLUMBING
  
OTHER OPERATIONS
*11
  
5
 Personnel with infections restricted
29
  
1
 Installed, maintained
*41
  
5
 Toxic items properly stored, labeled and used
*12
X
5
 Hands washed and clean, good hygienic practices
*30
 
5
 Cross-connection, back siphonage-backflow
42
  
1
 Premises: maintained, free of litter, unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel
13
  
1
Clean clothes, hair restraints
  
TOILET AND HAND-WASHING FACILITIES
 
FOOD EQUIPMENT AND UTENSILS
14
  
2
 Food (ice) contact surfaces: designed, constructed, maintained, installed, located
*31
X
4
 Number, convenient, accessible, designed, installed
43
  
1
 Complete separation from living/sleeping quarters, laundry
32
 
2
 Toilet rooms enclosed, self-closing doors, fixtures, good repair, clean: Hand cleanser, sanitary towels/hand drying devices provided. Proper waste receptacles, tissue
15
  
1
 Non-food (ice) contact surfaces: designed, constructed, maintained, installed, located.
44
  
1
 Clean, soiled linen properly stored
 
CERTIFIED PERSONNEL
16
  
2
 Dishwashing facilities: designed, constructed, maintained, installed, located, operated
*45
     Management personnel certified Yes X No     Registered for class    
 
GARBAGE AND REFUSE DIPSOSAL
17
  
1
 Accurate thermometers, chemical test kits provided, gauge cook
33
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   QUAT 200 ppm                   Dishwasher Temperature   N/A °F or label
Food Temperatures:   TURKEY 39, PEPPERONI 39, CHICKEN 40, CHEESE TRIANGLES 39, TOMATOES 39, CREAMY DRESSING 40, DELI WALK-IN 42, GRAVY 186, CHEESE PIZZA 157, PEPPERONI PIZZA 160, BREAKFAST CROISSANT 155, ICE CREAM SOFT SERVE 36, YOGURT 43, MILK42
 
General Comments
HACCP CONCEPT DISCUSSED: PROPER HAND WASHING PRACTICES. 
Report and Instructions Received By   CRYSTAL KLONOWSKI /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  12/05/2017 Time In  10:35 AM Time Out  11:35 AM Sanitation Score  83 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  97  
 
Page 2 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM079  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  CASEY'S GENERAL STORE #3494 Address  421 N DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
*3  Observed the following potentially hazardous foods to be held at improper temperatures: Iced coffee machine had an internal temperature of 51. Provide for all cold potentially hazardous foods to be held at 41°F or below at all times except during necessary periods of preparation. 750.140. Temperature was turned down due to product being freshly changed out. Immediate/Onsite
*12  Observed an employee drink/drinking in the following location(s): On the shelf with other food items in the deli walk-in. Provide for all employee drinks be stored in one location separate from food intended for consumer sale. 750.530. Immediate/Onsite
*31  Observed the following hand sink(s) to be inaccessible: Sanitizer bucket was placed in the back kitchen hand sink completely filling the whole sink. Provide for all hand sinks to be accessible at all times to assure that proper hand washing occurs. 750.1120. Immediate/Onsite
2  Observed the following bulk food products to not have proper labels on the container: Containers of extra frosting/glaze were not labeled. Provide for all bulk food bins/containers to be clearly labeled with the common name of the food product contained. 750.130 Next Inspection
8  Observed the following food products to be improperly stored: Pan of pre-portioned potato wedges in the walk-in freezer were not covered. Provide for all food products in storage to have proper covers or overhead protection. 750.120 Next Inspection
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   CRYSTAL KLONOWSKI /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  12/05/2017 Time In  10:35 AM Time Out  11:35 AM Sanitation Score  83 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  97  
 
Page 3 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM079  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  CASEY'S GENERAL STORE #3494 Address  421 N DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
     
     
Report and Instructions Received By   CRYSTAL KLONOWSKI /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  12/05/2017 Time In  10:35 AM Time Out  11:35 AM Sanitation Score  83 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  97